| Lcdc | |
|
132 Hillside Ln Desoto TX 75115-5910 | |
| (469) 321-1346 | |
| Not Available |
| Full Name | Lcdc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 132 Hillside Ln, Desoto, Texas |
| Authorized Official Name and Position | Mylan Watson-shaw (LICENSED CHEMICAL DEPENDENCY) |
| Authorized Official Contact | 4693211346 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lcdc 132 Hillside Ln Desoto TX 75115-5910 Ph: (469) 321-1346 | Lcdc 132 Hillside Ln Desoto TX 75115-5910 Ph: (469) 321-1346 |
| NPI Number | 1750046074 |
|---|---|
| Provider Enumeration Date | 11/02/2021 |
| Last Update Date | 11/10/2021 |
| Certification Date | 11/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750046074 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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